Financial Support in an Underserved and Low-Income Population With Heart Failure (FUND-HF)

The goal of this clinical trial is to test whether financial support in the form of a one-time $500 stipend would improve medication adherence and quality of life in low-income, socially-needy patients with heart failure with reduced ejection fraction in the post-discharge setting. The main questions it aims to answer are: Will financial support improve medication adherence? Will financial support improve heart failure quality of life? Participants will complete surveys on quality of life, social stress, and spending habits at their baseline visit. Participants will be randomly assigned to receive $500 at their baseline visit or $0 at their baseline visit. At their one month visit, medication adherence and quality of life will be assessed. These results will be compared between groups. The group that received $0 at their baseline visit will be provided $500 at their one-month visit and return for a two-month visit. At that visit, medication adherence and quality of life will be assessed. These results will be compared to their one-month results. Researchers will compare the 1-month medication adherence and quality of life scores between the immediate financial support vs delayed financial support. Researchers will also compare 1-month vs 2-month adherence and quality of life data for participants who were randomized to the delayed financial support group.

This group will receive no financial support at their completion of their baseline visit, but will receive $500 at their 1-month visit.

The first co-primary outcome will be a medication adherence outcome. This will be ascertained using serum therapeutic drug monitoring of guideline directed medical therapies.

The first co-primary outcome will be a medication adherence outcome. This will be ascertained using serum therapeutic drug monitoring of guideline directed medical therapies.

Quality of life will be ascertained using the KCCQ-12, a validated measure of quality of life among patients with heart failure. The score contains four domains, physical limitation, symptom frequency, quality of life, and social limitations. Each subdomain provides an individual score from 0 to 100, with 0 denoting the worst and 100 denoting the best possible health. These scores are averaged and presented as a summary score.

Quality of life will be ascertained using the KCCQ-12, a validated measure of quality of life among patients with heart failure. The score contains four domains, physical limitation, symptom frequency, quality of life, and social limitations. Each subdomain provides an individual score from 0 to 100, with 0 denoting the worst and 100 denoting the best possible health. These scores are averaged and presented as a summary score.

Self-reported medication adherence will be captured by the Morisky Medication Adherence Scale. This scale is an eight-item survey. The score ranges from 0-8, with higher scores denoting greater adherence.

Self-reported medication adherence will be captured by the Morisky Medication Adherence Scale. This scale is an eight-item survey. The score ranges from 0-8, with higher scores denoting greater adherence.

This will be captured using the perceived stress scale. This is a ten-item survey assessing perceived stress over the last month. The scores range from 0-40, with higher scores denoting higher perceived stress.

This will be captured using the perceived stress scale. This is a ten-item survey assessing perceived stress over the last month. The scores range from 0-40, with higher scores denoting higher perceived stress.

This is a ten-item instrument measuring psychological distress. Each item has a five-level response scale. The range is 10-50, with higher scores denoting greater psychological distress.

This is a ten-item instrument measuring psychological distress. Each item has a five-level response scale. The range is 10-50, with higher scores denoting greater psychological distress.

This outcome will be captured through review of the electronic medical record and adjudicated using the DFW Hospital Consortium

This outcome will be captured through review of the electronic medical record and adjudicated using the DFW Hospital Consortium

This outcome will be captured through review of the electronic medical record and adjudicated using the DFW Hospital Consortium

This outcome will be captured through review of the electronic medical record and adjudicated using the DFW Hospital Consortium

Inclusion Criteria: Age > 18 English speaking participants who completed SOCIAL-HF study surveys Ejection Fraction <=40% and eligible for at least one component of GDMT Has at least some difficulty paying monthly bills (Somewhat Difficult and Very Difficult) Annual household income <130% Federal Poverty Limit Have at least two additional social needs based on the following domains: Cost-related nonadherence Food Insecurity Housing Instability Transportation Difficulty Unemployment Household Crowding: Person/Room Ratio >1 Rent Burden: Rent/Income Ratio >30% Low social support Interpersonal Violence History of Discrimination Exclusion Criteria: Unwilling to return for 1 and 2-month follow-up visits. Currently in jail or prison Primary residence outside Dallas County Legal Blindness Systolic blood pressure <90 mmHg on screening Contraindications or Intolerance all medications available for therapeutic drug monitoring (metoprolol, losartan, lisinopril, valsartan, and spironolactone) Unable to answer orientation questions.

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